Wednesday, 11 October 2017

Autism or Autistic Spectrum Disorder as it is formally known, is a neurodevelopmental disorder arising in childhood characterised by abnormal social communication and interaction and restricted, repetitive or stereotyped behaviour, interests. and activities.

What causes Autism?

The causes of Autism is unknown and are likely multifactorial in nature. Research suggests that there is a genetic component but the exact genes involved remain unknown. In recent years, childhood immunisations have been blamed for causing Autism but this myth has been largely debunked.

What are the early warning signs of Autism?

Babies or toddlers with Autism may manifest early signs such as poor eye contact when fed or smiled at, not waving goodbye or using gestures to communicate, not responding to a familiar voice or when his or her name is called. They may have delays in speech developement. They can also adhere more ridgidly to routines and may show perculiar and fixations to certain activities, often repeating them incessantly.

How is Autism diagnosed?

Autism is diagnosed by specialists like developmental paediatrician, neurologists, psychiatrists or clinical psychologists. Careful history taking from the parents and obeserving the behaviour of the child will help the specialists come to a diagnosis. At times, autism scales can be used to assist in this process.

Monday, 25 September 2017

Are there any trends in the way social media addiction occurs or presents itself?
The underlying behavioral addiction symptoms and profile of patients remains the same but the apps or websites addicted to changes with time and fad. Social media addiction is now more associated to the use of smartphones than the personal computer.

What health problems can social media addiction cause?
The main harm is the disruption to one's life and routine causing social difficulties. For e.g., a student may stop going to school. If one tends to spend most time on social media and stop tending to his or her food intake, neglect regular exercising and sleep, this can lead to general ill health.

Many people might not even be aware they are addicted to social media. What are the signs that individuals and family members can look out for?
Loved ones often have the unenviable position of determining if the usage of social media is indeed excessive. I have seen cases where parents overreact to normal usage and at other times being unaware that their children have lapsed into addiction. If loved ones notice that the patient is spending more and more time on social media, is neglecting their studies or work, tends to be sleepy in the morning as they are using social media excessively at night or become irritable or aggressive when pointed out that they are overusing, they can seek help with professionals to determine if the patients have an addiction problem.

What are some tips on overcoming the addiction?
We cannot avoid the use of social media as it is a great resource and it will be important for parents and school to educate on responsible usage. Prevention is always superior to cure. Putting away ones' devices from time to time and having digital detox is useful. Always remember to designate areas and time of the day when devices like your smart phone should be put away. This includes at the dinner table and at bedtime. Continue to prioritize ones' friends and loved ones and having time with them in the real world than to just communicate via social media. Lastly, have real life hobbies and exercise regularly to have a good balance.

Should internet addiction as a whole be formally recognised as a disorder, why, and what difference it would make to treatment and tackling the addiction?
Yes as it is the main type of behavioral addiction together with other forms of internet addiction at the moment. This will help bring awareness to afflicted individuals and loved one, allow for specialized services and programmes to be set up and allow for better outcomes for the patients.

Monday, 18 September 2017

Are such social media addiction cases on the rise in comparison to previous years? If so, what is the increase?
The numbers have been quite similar in the past two to three years. It became more of an issue since smart phone usage proliferated.

Do you think this is an issue that is set to grow bigger?
Before it was mainly Facebook, but now there is Instagram, Snapchat etc.
Internet and social media addiction have been a problem in the past decade since Facebook. The app used may change but the underlying harmful and addictive use of social media apps remains fundamentally the same.

Which sites are patients addicted to? What type of symptoms do patients with this form of addiction present with?
Most patients are addicted to a number of websites and apps. These may include common social media platforms, photo sharing apps, music / karaoke apps, internet gaming with social elements and online forums.
They tend to spend excessive amounts of time on social media. This leads to harm and disruption in their life, such as missing school or not fulfilling their daily responsibilities. They later need to spent more and more time on social media in order to get the same tkick as before. Eventually, social media may become the centre of their life and they are perpetually preoccupied with using it or thinking constantly of going on it all the time. When denied usage, they may feel very uncomfortable or even become agitated.

What is the typical profile of the patients you see? Any university students?
Many are teens to young adults. Both male and female. Almost always school going. There are university students as well.

Do the patients present with any co-occurring addiction or other medical conditions?
They usually present with co-morbid insomnia, depression and anxiety disorders.

What causes social media addiction?
Causes are unknown. They may be related to genetic predisposition to behavioral addiction. Patients may have derive pleasure and excitement from having likes, followers or positive comments from their posts and this lead to reinforcement of the behavior of excessive usage. In fact, it appears that individuals with little "real life" social networks tend to more easily fall prey to social media addictions.
In cases with insomnia, they may find social media a means of dealing with their sleeplessness, having no one to talk to in the wee hours. Many with anxiety disorders and depression resort to using social media as a means to reach the outside world when they are withdrawn at home. The thrills and excitement they derive from social media and internet gaming may be the only stimulation they derive from life leading to excessive usage and addiction.

Wednesday, 31 August 2016

From your expert perspective, at what age is it deemed OK for parents to leave their child at home alone?

It is difficult to define a specific age as children vary in their development and maturity. Pre-schoolers and those under 10 years of age must not be allowed to stay alone at home. Beyond ten, it becomes controversial. In the legislation of some foreign jurisdiction, children up to 15 years old are not allowed to stay at home. As each child is different, it will be best for parents to understand their child's temperament, maturity level and his or her propensity towards being impulsive to determine if their child can be safely left alone at home.

If a child has to be left alone for any period of time, what tips do you recommend to parents in order for them to keep their child safe?

Firstly, never take safety for granted. Look into safety features such as locking the window grilles. Also, make sure that you are contactable so that the child can reach you immediately if he becomes frightened or has any needs. Having a good relationship with your neighbours will be important as they can sometimes keep a look out for you and the child can also approach them should any emergencies or needs arise.

Tuesday, 23 August 2016

Q3: Often, men (dads) seemed to be neglected in the equation of achieving parenting (psycho-emotional) wellness. Why is that so – is it true that they are less susceptible to post-natal and parenting blues?

Post-natal blues by definition pertains only to mums. However, while less likely than mums, dads are vulnerable to parenting blues or even depression. In general, due to societal expectations, the responsibility of child care and parenting still falls on mums. We have tax relief to help working mothers and much longer maternity leave and this is testament that mothers are expected and more likely to sacrifice their careers to care for their child.

In most circumstances, it is natural that the child forms a much stronger attachment to mums than dads because of the child birth process and breast feeding. As such, the stress and responsibilities that falls on a father is much less. However, societal expectations are shifting. These days, the demands for a dad's involvement in child care and parenting is increasing and we are seeing more fathers who are finding it stressful and having difficulties balancing work and child care, and consequently getting blue.

Q4: Lastly, what can parents do to alleviate fears and anxiety? Is the attitudinal approach the best way to prevent it? Any tips?

As a society, we may want to be more cognizant of the difficulties new parents may face, particularly in this age of small nuclear family with little or no support from extended family. Much has been done to alleviate the financial aspects, as well as to provide longer maternity and paternity leave.I believe as a society we can still do more to educate and support parents.

Other than attitudinal change, maintaining healthy family dynamics and a strong couplehood will improve support to the parent, allow them to talk about their fears and anxiety and prevent feelings of isolation. Mum and Dad must continue to spend time with each other and go "pak tor". Improving parental relationship will help with improving the care of the child and there is no need to feel guilty for leaving the child behind. Mum and Dad must also have their alone time so that they can have time of the stress of care and continue with their hobbies and meeting up with peers. The other spouse must recognise the need for alone time and not begrudge the other party but instead take turns to do so while the other cares for the child. Commonsensically, parents do need to sleep well, eat healthily, exercise and manage the stress from their career in order to keep these fears and anxiety at bay.

If the blues, anxiety and fears are serious, in that they affect the parent's ability to care for the child or to work, he or she should seek professional help and treatment Postnatal depression and Anxiety disorders can be effectively treated with medications and therapy. Denial of the conditions and leaving them alone can have dire consequences.

Tuesday, 16 August 2016

As with most psychological conditions, exact causes are not known. However, we can understand the reasons from biological, psychological and social cultural factors. Some individuals may be genetically vulnerable to having these conditions and there may be a family history.

After pregnancy, there is also a fluctuation in female hormones which results in a risk of post natal; blues and even depression in mothers.

Psychologically, parents may not be prepared for the stress of a new child. There may be a discrepancy between their expectations and reality and only realise that caring for a newborn may not be as easy as it seems, leading to feelings of incompetency, fear and low mood. If the newborn has a difficult temperament, parents may have an even harder time to cope resulting in further stress.

Socio-culturally, especially in present days of having one to two children and every child is precious, there can be a lot of pressure from spouse, in-laws and grandparents to be overly protective to the child and to give the child the best. Conversely, lack of support and marital dysfunction can also lead to fears and blues.

Q2: Stress and anxiety from caring for infant is often identified as the culprit for post-natal depression. To what extent is this true? How can parents adjust expectations and would that help to alleviate post-natal depression?

Stress and anxiety are definitely symptoms which may indicate that there is an increase in the possibility that the mother may be or will be having post-natal depression. It is more pertinent to address the psychosocial issues that are causing these stress and anxiety.

It is sometimes not only the parents, but also those around them and even media portrayal that leads to difficult expectations. For example, many mothers have the stress of having to breastfeed there newborn perfectly and feel guilty when they are unable to due to physical reasons. The intense guilt then leads to depression.

It will be helpful if would be parents are exposed to and educated about the potential difficulties that they may face. Most parents will give their best when caring for their child, and there is no need for perfection or comparison with others. Support and reassurance from spouse and family members are equally important.

Saturday, 13 August 2016

Question: Please share your opinion on the psychological benefits that spending in the outdoors can give to - babies, toddler, children and the family.

For children, even at an infant stage, playing is the main way of which they learn social interactions and other skills necessary for normal development. Outdoor activities are an important aspect of play. Outdoor activities allow for the possibility of playing in a large group and enhances the child's social skills and ability to work in a team. Ability to work and to get along with others is a crucial predictor or success in the future. Playing together also enhances the relationships of the family.

Outdoor activities also helps by allowing the child to use the whole of his body during play and this trains coordination, balance and spatial sense. Acquiring these skills and becoming physically stronger and healthier from sports and outdoor activities help a child feel more confident and increases his overall sense of wellbeing.

Getting sunshine outdoors is beneficial too. Getting adequate sunshine helps to regulate the circadian rhythm of our body and allows for better sleep at night and wakefulness in the day. Sunshine is also a natural antidepressant and brings about a positive mindset. Just be sure to drink adequate amount of water and put on your sunblock!

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Dr Lim Boon Leng (Dr BL Lim) is a psychiatrist in private practice who treats children, youth, adults and the elderly. He has special interests in depression and other mood and anxiety disorders, Adult ADHD / ADD as well as youth psychiatry.

He is known to be an approachable, reassuring and good-natured psychiatrist. He recommends a consultative and collaborative approach between the doctor and the patient as he believes this to be the best way for you to achieve a good recovery and wellness in your mental health.